Медицинская и хирургическая урология
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Racial Disparities in the Treatment of Benign Prostatic Hyperplasia

Harcharan Gill

Purpose: Benign prostatic hyperplasia (BPH) affects the majority of men over the age of 50 years. Management of patients with symptomatic BPH includes surveillance, medication, and surgery. We examined ethnic differences in BPH treatment in a diverse population with similar healthcare access and socioeconomic status.

Materials and methods: We searched the California Medi-Cal database comprising over 7 million persons from 2000 to 2005 for patients who had been enrolled in Medicaid for at least one year before a new diagnosis of BPH. We collected information on age, race, presenting symptoms and management.

Results: Our study included 53,172 men at a mean age of 67 years with 35% white, 9.3% African-American, 18.1% Hispanic, 23% Asian, and 4.3% other. Medications were prescribed to only 45% of all patients, with 98.1% of treated patients receiving alpha blockers and 9.6% receiving 5 alpha-reductases inhibitors. After controlling for age at diagnosis, African-Americans were far less likely to be treated (28.6%) in the first year of diagnosis compared to patients of other races: whites (44%), Hispanics (43.5%) and Asians (53.5%) (p < 0.05). Surgery was performed in 6.1% of patients within one year of diagnosis. Compared with whites, both Asian and African-Americans were less likely to have surgical intervention (OR 0.63, and 0.83, respectively, p < 0.05) while Hispanics were more likely to be operated (OR 1.5, p < 0.001).

Conclusions: In a population of patients with supposed equal access to care, racial disparities exist in the treatment of BPH. This may reflect differences in cultures and expectations within the different ethnicities.